Shame Upon Thee, Humana Insurance

By consumerist.comNovember 28, 2006

Kostt writes:

“My parents are both in a nursing home and I had to enroll them in a drug plan and chose Humana. I told Humana their living situation and that I needed a “no premium” plan because they have no income. The girl explained to me that the $48.32 plan was best suited for them. Never told me there was a plan with no premium. Needless to say I have paid for almost the whole year, these premiums for each parent ($48.32). I then called Humana because the nursing home informed me that they should not be charging a premium.”

Shameful behavior continues, inside…

“My parents are both in a nursing home and I had to enroll them in a drug plan and chose Humana. I told Humana their living situation and that I needed a “no premium” plan because they have no income. The girl explained to me that the $48.32 plan was best suited for them. Never told me there was a plan with no premium. Needless to say I have paid for almost the whole year, these premiums for each parent ($48.32). I then called Humana because the nursing home informed me that they should not be charging a premium.

Contacted Humana and they told me I would have to fax an appeals letter to see if I could be refunded. Well guess what, they informed me that they cannot refund any monies. So you need to let people know that there is a plan with no premium that does the same thing that the $48.32 plan did. So I have spent over $750.00 and they don’t feel the need to look into this.

Also, customer service is terrible. I called the other day at 3:45 p.m. and until I got done with this mess it was 5:15 p.m.!!!!!!!!! Another time when I called about finding about this had a customer service rep. yell at me and told me I didn’t know what I was talking about. I asked to speak to her supervisor and after another long wait the supervisor got on and apologized, customer service rep. was wrong, imagine that. I think for the elderly to have to deal with this on there own is a shame. And shame on Humana for taking premiums from the elderly who are living in a nursing home and where all their income goes to. SHAME! SHAME!”

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If you have not already done so, contact your state insurance department or research your state insurance laws. The National Association of Insurance Commissioners at http://www.naic.org is a good gateway resource, providing general information, a link for each state and a consumer affairs/complaints section. Insurance contracts, pricing rules, guidelines for quotes and misdeeds in the insurance industry are regulated on a state rather than federal level with many differences from state to state. Fraudulent conduct by an insurer is taken extremely seriously by the insurance departments, which can be like a Better Business Bureau or Consumer Protection Board on steroids. A written request to your insurer that cites an applicable regulation by the state insurance department, or perhaps even a cc to the relevant office, is likely to be extremely persuasive.

I can’t judge whether there was fraud or illegal misconduct here per se and I can’t give you legal advice, but I want to ensure everyone understands that insurance is much, MUCH more regulated and consumer-protected than, say, cell phone contracts.

It is unfortunate that you had a run in with Humana. I work in the medical billing industry and I hate having to call them and get denied claims reprocessed for the same reason you described, you are on the phone forever.
Do exactly what miss_smartypants says and quickly. Time is not on your side when it comes to these issues. If you need to have insurance for your parents, talk to the nursing home and find out which companies are easy to deal with. They should know from experience.

The health insurance industry is simply the best example of the worst that can come from purely money-minded capitalism. If there’s an industry out there that deserves to be not just put out of business, but actually lined up against a wall and shot, it’s these guys. Yes, Humana is bad, but only in the sense that an apple with a worm in it is “bad” in a basketful of maggots.

Faced with the option of sinking endless money on a loophole-ridden policy backed by bloodsuckers who would gladly ruin my life for a dollar if they thought they could get away with it, I actually feel relatively lucky to be among the tens of millions in this country who aren’t “worth” insuring as far as these parasitic companies are concerned. I’d rather not have their “help” anyway. I honestly feel that I have a better chance with that money in my bank account and no help whatsoever.

I bet the advent of privatized insurance has necessitated the building-out of a whole new wing of Hell.

I have had a different problem with Humana. I got authorization to see a provider, went to this provider, and 3 weeks later Humana DENIED THE CLAIMS. After I had verified with Humana that this provider was in their network.

I have had to make numerous calls, emails, letters and have also complained to the state. Humana is starting to pay these claims, but it is taking forever. They are also claiming a “claim adjudicator” problem and say that their computer system “failed to pull the correct pricing information!” In this day and age, I find that extremely hard to believe- especially when this company from HELL made over $1.3 billion net profit last year! They can’t fix a simple computer integration error??? Yep. That’s what Humana Corporate told me yesterday morning.

By the way, ChickyMama, I don’t envy you your job. If you have any information about Humana post it online so we can shmear these sob’s out of business. Please see my complaint at:[www.my3cents.com]